Quality of life in chronic kidney disease: a community perspective using world health organization quality of life: BREF questionnaire

Sabitha R. Jacob, Suthanthira Kannan, Rini Raveendran, Tom Wilson


Background: The quality of life is an important assessment tool in improving the quality of care among chronic kidney diseases (CKD) especially in a palliative care setup. This study attempted to assess the quality of life of chronic kidney disease patients.

Methods: This community based cross sectional study was conducted among 140 patients who were registered at palliative clinics in Malappuram District, Kerala using a standard tool for quality of life (QOL) in Malayalam version. Domain scores were analysed across clinic epidemiological factors.

Results: Mean age of the study population was 53.99 (14.36%). Majority 73 (52.1%) were educated up to upper primary. The median duration of CKD was 4 years and ranged from 3 months to 22 years. 55.3% were undergoing dialysis 16.3% had renal transplantation. Hypertension was reported by 65% and diabetes by 50.7%. The highest score was obtained in the environmental and lowest in the psychological domain. Age below 40 years, male gender and provision of an income was associated with better QOL scores and perception scores. QOL was significantly higher in all domains among those who had undergone renal transplantation compared to those on hemodialysis.  

Conclusions: The status of renal transplantation and younger age group positively affected the good quality of life. Considering the cost of renal transplantation and post-transplant survival peritoneal dialysis could be promoted in low resource settings. Secondary prevention of hypertension and diabetes should be addressed at programme level to delay nephropathy.   


Chronic kidney disease, Quality of life, Transplantation, Dialysis, Kerala

Full Text:



WHO, WHOQOL: Measuring Quality of Life. WHO. World Health Organization; Available at: survey/whoQOL-qualityoflife/en/. Accessed on 02 March 2020.

Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet. 2016 8;388 (10053):1459-544.

Anand S, Shivashankar R, Ali MK, Kondal D, Binukumar B, Montez-Rath ME,etal. Kidn Int. 2015;88(1):178-85.

Agarwal SK. Chronic kidney disease and its prevention in India. Kidn Int. 2005;68:S41

Anupama YJ, Uma G. Prevalence of chronic kidney disease among adults in a rural community in South India: Results from the kidney disease screening (KIDS) project. Ind J Nephrol. 2014;24(4):214.

Agarwal SK, Srivastava RK. Chronic kidney disease in India: challenges and solutions. Nephr clini practi. 2009;111(3):c197-203.

Boini S, Frimat L, Kessler M, Briançon S, Thilly N. Predialysis therapeutic care and health-related quality of life at dialysis onset (The pharmacoepidemiologic AVENIR study). 2011;9(1):7. Available at: content/9/1/7. Accessed on 20 June 2020.

Brown J, Bowling A, Flynn T. Models of quality of life: a taxonomy, overview and systematic review of the literature. Proceedings of European Forum on Population Ageing Research. Sheffield, UK; June 2004.

Megari K. Quality of life in chronic disease patients. Heal Psychol Res. 2013;23(1):e27.

Chapter 1: Definition and classification of CKD. Kidney Int Suppl. 2013;3(1):19-62.

Sathvik BS, Parthasarathi G, Narahari MG, Gurudev KC. An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire. Ind J Nephrol. 2008;18(4):141.

Sreedevi A, Cherkil S, Kuttikattu DS, Kamalamma L, Oldenburg B. Validation of WHOQOL-BREF in Malayalam and Determinants of Quality of Life Among People With Type 2 Diabetes in Kerala, India. Asia Pac J Public Health. 2016;28 (1):62S-9S.

Carrero JJ, Hecking M, Ulasi I, Sola L, Thomas B. Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective. Seminars in Nephrol. 2017;37.

Lemos CF, Rodrigues MP, Veiga JRP. Family income is associated with quality of life in patients with chronic kidney disease in the pre-dialysis phase: A cross sectional study. Health Qual Life Outcomes. 2015;13:202.

Tüzün H, Aycan S, İlhan MN. Impact of comorbidity and socioeconomic status on quality of life in patients with chronic diseases who attend primary health care centres. Cent Eur J Public Health. 2015;23(3):188–94.

Mujais SK, Story K, Brouillette J, Takano T, Soroka S, Franek C, et al. Health-related quality of Life in CKD patients: Correlates and evolution over time. Clin J Am Soc Nephrol. 2009.

Aggarwal HK, Jain D, Pawar S, Yadav RK. Health-related quality of life in different stages of chronic kidney disease. Int J Medi. 2016.

Joshi U, Subedi R, Poudel P, Ghimire PR, Panta S, Sigdel MR. Assessment of quality of life in patients undergoing hemodialysis using WHOQOL-BREF questionnaire: a multicenter study. Int Journal Nephrol Renovasc Dise. 2017;10:195.

Pereira RM, Batista MA, Meira AD, Oliveira MP, Kusumota L. Quality of life of elderly people with chronic kidney disease in conservative treatment. Revista Brasileira Enfermagem. 2017;70(4):851-9.

Atapour A, Nasr S, Boroujeni AM, Taheri D, Dolatkhah S. A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis. Saud J Kidn Diseas Transplant. 2016;27(2):270.

Tannor EK, Archer E, Kapembwa K, Van Schalkwyk SC, Davids MR. Quality of life in patients on chronic dialysis in South Africa: a comparative mixed methods study. Bio Med Cent nephrol. 2017;18(1):4.

Zazzeroni L, Pasquinelli G, Nanni E, Cremonini V, Rubbi I. Comparison of quality of life in patients undergoing hemodialysis and peritoneal dialysis: a systematic review and meta-analysis. Kidn Blood Press Resear. 2017;42(4):717-27.

Purnell TS, Auguste P, Crews DC, Lamprea-Montealegre J, Olufade T, Greer R, Ephraim P, Sheu J, Kostecki D, Powe NR, Rabb H. Comparison of life participation activities among adults treated by hemodialysis, peritoneal dialysis, and kidney transplantation: a systematic review. Americ J Kidn Disea. 2013;62(5):953-73.

McAdams-DeMarco MA, Olorundare IO, Ying H, Warsame F, Haugen CE, Hall R, Garonzik-Wang JM, Desai NM, Walston JD, Norman SP, Segev DL. Frailty and postkidney transplant health-related quality of life. Transplant. 2018;102(2):291.

Von der Lippe N, Waldum B, Brekke FB, Amro AA, Reisæter AV, Os I. From dialysis to transplantation: a 5-year longitudinal study on self-reported quality of life. BMC nephrology. 2014;15(1):1-9.